Organization
PSG SERVICES, LLC
Active
Other names
DBA Interim Healthcare
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BERNARD D BULGER (ADMINISTRATOR)
(708) 422-2934
Entity
Organization
Contact information
Practice address
12855 S CICERO AVE, SUITE 200, ALSIP, IL 60803-3043
(708) 422-2934
(708) 422-5528
Mailing address
12855 S CICERO AVE, SUITE 200, ALSIP, IL 60803-3043
(708) 422-2934
(708) 422-5528
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
1010247
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000002649
HUMANA PROVIDER NUMBER
IL
01
—
2154
PROF BUSINESS ADM
IL
05
—
37144249001
—
IL
01
—
50180
BLUE CROSS PROVIDER NUMBE
IL
01
—
5215621
AETNA PROVIDER NUMBER
IL
01
—
N306219
WELLCARE PROVIDER NUMBER
IL
Enumeration date
03/27/2006
Last updated
07/10/2013
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